Appropriate clinical communication between patients and physicians requires better cooperation based on patientphysician rapport and consensus development through information sharing.Developing appropriate clinical communication is also important for safer and more reliable clinical care. The aim of the present study was to illustrate an effective politeness strategy for appropriate clinical communication.
1) We conducted focus-group interviews and performed qualitative analysis on the basis of the results of interviews of both patients and physicians.We also performed an Internet survey and organized an Internet-based discussion ofthe politeness strategy and its effectiveness.
2) Patients may consider physicians' overuse of honorifics as feigned politeness, Both patients and physicians recognize that such overuse may work against the development of rapport-based cooperation.
3) Patients may expect physicians to use simpler honorifics, such as “-san.”However, by using honorifics physicians can show respect to patients and establish a more intimate relationship with patients through both positive and negative politeness strategies.
4) When physicians can better understand and use local dialects, the effects of positive politeness may reduce the psychological distance between patients and physicians, have a relaxing effect on patients, and improve clinical information gathering.
5) A positive politeness strategy, such as admiring and talking optimistically, may have different effects depending on the patient's condition or“face.”If successful, this strategy can contribute to the behavioral changes of patients.

To raise a level of safety and to enhance the effectiveness of complicated drug therapy, various drug monitoring programs have been implemented in these days. In the present study, we examined whether pharmaceutical care plans proposed by pharmacists contributed to drug therapy.The number of pharmaceutical proposals from pharmacists, which were adopted and put into poactice in the clinical stages, has increased annually and totaled 1,014 cases in the past four years. The number of proposals related to cancer chemotherapy increased remarkably. Moreover, most of the cancer-related proposals conserned drug dosage, suggesting that the pharmaceutical care by pharmacists may contribute to the safety management of drugs in drug therapy. Additionally, in the other clinical cases than cancer chemotherapy cases, there was an increase in the number of proposals based on patient's conditions and clinical examination data, which suggests frequent participation of pharmacists in drug therapy. Furthermore, it was found that 62.6% of the all pharmaceutical proposals were made by wards-resident pharmacists. This suggests that an increase in the numbrt of wards-resident pharmacists will contribute to more effective and safer drug therapy in the future.
pharmacotherapeutic ; Safety ; seconds ; Clinical ; Drug Monitoring

The objective of this study was to investigate associations between societal mutual assistance and vital functions among Aged People in rural Districts. This cross-sectional survey used questions based on the Anderson Behavioral Model, including relevant items such as “Individual characteristics (predisposing, enabling, and need factors)” and “Community characteristics (physical factors)”. We distributed questionnaires to 2,500 people and used 974 valid responses for study analyses. Our results showed that older adults in rural districts with lower levels of societal mutual assistance tended to have lower vital functions levels. Also, actual lower vital functions levels appear to be associated with lower levels of “Living in harmony with nature” and “No available social groups to participate in” at the group or community level, which define vital functions. It is necessary to objectively review self- and mutual-assistance roles of older adults living in rural areas as well as the mutual and public assistance functions that are typically involved in public health services.

In this study, we conducted text analysis to clarify the “feelings and considerations about the community (thoughts on the community)” of aged individuals in depopulated rural districts with low birth and high death rates, to identify a basis for public health nurse activities that contribute to improved functioning of aged individuals in rural areas. Quantitative text analysis was performed on free descriptive data collected from 362 aged individuals in rural districts; a co-occurrence network was created and correspondence analysis was performed. Six categories were extracted by analyzing the structure of the co-occurrence network: “loneliness because of the increasing number of unoccupied houses with few children and young people around”, “changes in the neighborhood and relationship with neighbors over time”, “continuous aging and depopulation of the village”, “preciousness of living with and spending time with family”, “maintaining good health and healthy aging”, and “difficulties and worries about inconvenient access to hospitals, public administrative offices, and shops”. Correspondence analysis of extracted words identified “inside the town”, “difficult”, “depopulation”, and “town” as factors strongly contributing to the principal component. The categories revealed by text analysis in this study may indicate an approach to develop the community, through objectively analyzing and then best utilizing self-care and mutual care in aged individuals in rural districts and social solidarity and governmental care (e.g., public health services).

Objective: This study aimed to clarify the association between social mutual aid and psychological stress among residents in a rural district.Materials and Methods: A cross-sectional study based on Andersen’s Behavioral Model of Health Care Utilization was conducted on 2,500 residents of City A in Akita Prefecture who were aged 65 years or older. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on individual characteristics (predisposing, enabling, and need) and contextual characteristics (physical factors).Results: Responses were obtained from 1,236 participants, and data from 974 valid questionnaires were analyzed. Factors related to the high level of psychological stress were “maintenance of confidential relationships that could only be formed in the rural district (low)” and “social support (low)”, which are forms of social mutual aid. Use of health services had no association with psychological stress, whereas when psychological stress was high (5 points or higher), the rate of “not participating in community groups (no)” was also high.Conclusion: The findings of this study indicate the need for the objective evaluation of the roles of self-help and mutual help among elderly adults living in a rural district and the mutual help and public help functions represented by health services. It is also important to develop districts that promote the enhancement of social mutual aid so that such help can be fully utilized.